超声内镜诊断胰胆管合流异常

Endoscopic ultrasonography for diagnosing pancreaticobiliary maljunction

目的观察超声内镜(EUS)诊断胰胆管合流异常(PBM)的价值。方法纳入45例疑诊PBM患者,其中25例入院后经内镜逆行胰胆管造影(ERCP)(n=4)或手术(n=21)确诊PBM。以ERCP或手术结果为金标准,评价EUS诊断PBM的效能,并与经腹超声、CT及MRI进行比较。结果45例中,EUS示25例PBM,其中1例经手术排除PBM;EUS结果显示20例阴性,其中1例经手术确认PBM。EUS诊断PBM的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为96.00%(24/25)、95.00%(19/20)、96.00%(24/25)、95.00%(19/20)及95.56%(43/45)。EUS诊断PBM的效能与经腹超声、CT、MRI诊断PBM差异均有统计学意义(P均<0.01)。EUS诊断PBM与ERCP/手术的一致性较好(Kappa=0.910,P<0.001),而与MRI的一致性较差(Kappa=0.393,P<0.05)。结论EUS诊断PBM的价值较高,可作为疑似PBM的首选影像学检查手段。

Objective To observe the value of endoscopic ultrasonography(EUS)for diagnosing pancreaticobiliary maljunction(PBM).Methods Data of 45 patients with suspected PBM were analyzed,among them 25 cases were diagnosed as PBM with endoscopic retrograde cholangiopancreatography(ERCP)(n=4)or surgery(n=21).Taken ERCP or surgery as gold standards,the efficacy of EUS for diagnosing PBM was evaluated and compared with that of transabdominal ultrasound,CT and MRI.Results Among 45 patients,EUS showed 25 cases of PBM,including 1 case was confirmed not PBM with surgery.Among 20 cases with negative EUS results,1 case was diagnosed PBM with surgery.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of EUS for diagnosing PBM was 96.00%(24/25),95.00%(19/20),96.00%(24/25),95.00%(19/20)and 95.56%(43/45),respectively.There were significant differences of the values for diagnosing PBM between EUS and transabdominal ultrasound,CT,MRI(all P<0.01).EUS had good consistency with ERCP/surgery for diagnosing PBM(Kappa=0.910,P<0.001),but poor consistency with MRI(Kappa=0.393,P<0.05).Conclusion EUS was of high value for diagnosing PBM,hence could be used as the first choice of imaging examinations for patients with suspected PBM.